Provider Demographics
NPI:1083921555
Name:SMARR, MARY JULIA (OTL)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JULIA
Last Name:SMARR
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:MRS
Other - First Name:M
Other - Middle Name:JULIA
Other - Last Name:SMARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTL
Mailing Address - Street 1:1140 STOURBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1880
Mailing Address - Country:US
Mailing Address - Phone:859-492-5678
Mailing Address - Fax:
Practice Address - Street 1:FIRST STEPS PROGRAM DEPARTMENT FOR PUBLIC
Practice Address - Street 2:275 E. MAIN ST. HS2W-C
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40621-0001
Practice Address - Country:US
Practice Address - Phone:877-417-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRO972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGO137Medicaid